This document summarizes a case study of a 56-year-old female patient with a history of systemic lupus erythematosus (SLE) who presented with shortness of breath, lower limb swelling, and decreased urine output. Examination revealed respiratory distress, leg edema, and lab results showed kidney dysfunction. Imaging showed pleural effusion, cardiomegaly, and kidney abnormalities. She was diagnosed with lupus nephritis and treated with hemodialysis, steroids, antibiotics, and other medications. Her condition improved with treatment.

1. By..
Dr/ Ahmed Shaban
Nephrology Fellowship of NMGH

2. Personal History
A 56 y/o female , housewife from Minyet elnasar ,has
4 offspring aged 33 ,26 ,25 ,22 ,has no special habits
Referred to our hospital with shortness of breathing
& lower limb swelling since 10 days & decrease
urine output & rising kidney function since 5 days.

3. Presented with shortness of breathing with
gradual onset ,progressive course and
associated at the same time with swelling of
both lower limbs started since 10 days & not
associated with chest pain & decrease urine
output since 5 days.

4. No DM , no HTN
History of SLE since 18 years appeared after the last
pregnancy presented with bloody rash & mouth ulcers
ANA : +ve
AntiDsDNA : -ve
C3 &C4 : decreased
24 h urinary protein : 343 mg/day
No history of hepatic or cardiac disease
No history of blood transfusion
No family history of similar condition
Positive consanguinity to her husband

5. By examination the patient appeared ill
Respiratory rate : 22 / min
Congested neck veins
Basal crepitation & decrease air entry on both sides
Audible S1 & S2 ,No added sounds
Abdomen lax & not enlarged
Bilateral lower limb pitting edema above knee

6. Investigations (upon admission)
HB: 8.6 g/dl
WBCs: 4.9 x 10³/ul
PLTs: 180 x 10³/ul
 Sr Cr :10.9
 Sr Urea : 300
 Sr k: 5.7 mg/dl
 Sr Na : 140
 INR : 4.95
PH 7.24 , Hco3 6 , Pco2 14

7. Radiological investigation
Chest Xray : Bilateral pleural effusion & increased
bronchovascular marking , cardiomegaly
ECG : Hyperkalemic changes (hyper acute T waves )
Ultrasound : Liver average size , average echogenicity ,
no focal lesion
Both kidneys average size (10 × 4) , Increased
echogenicity grade 2 , preserved corticomedullary
differentiation , cortical length 1cm
No stone , no back pressure
No ascites

8. Echo reveals :
Normal Left Ventricle dimensions with good systolic
function (EF 60 % )
Mitral Regurge grade 2/4
Thickened tricuspid valve
Slightly dilated Left Atrium
Rim of pericardial effusion about 5mm
Pulmonary pressure 35 mm/hg
No visible intra cardiac thrombi or masses

9. Albumin : 2.2
Ca ; 8.8
Po4 : 5.7
ALT 21
AST 13
T.Bilirubin : 1.2
D.Bilirubin : 0.1

10. Hospital course
Patient take Na bicarbonate 2 amp (186 mg)
Femoral catheter for HD & take a session of HD &
Dyspnea subsides after HD
Prepared for Biopsy for confirmation of Lupus nephritis
Echo
Daily follow up S.Cr , S. Urea , ABG
Daily fluid chart

11. PLTWbcsHBPco2Hco3PHKNaS.Ure
a
S.Cr
1804.98.61467.245.714030010.9
1384820157.404.41452748.8
1693.97.72214.37.423.61411716.4
1311.77.222137.44.31382037.3
2062.47.21811.77.424.11372418

12. UFOutputInputU.O.P
1000 dialysis500200
1000 dialysis700300
4001400
1000 dialysis1501400

13. We Recommend
Fluid chart
Biopsy & follow up Bl pressure , urine colour
Daily full lab
Daily dialysis for pericarditis

14. Patient improved with hemodialysis
Biopsy was taken
First discovered HTN

15. Treatment
Lasix 80 mg / 8 h
Epilate 20 mg / 8 h & Nivobiol 5mg OD
Solupred 500 IV OD for 3 days then 60 mg oral till biopsy
result
Albumin 500mg / 100ml IV OD
Na bicarbonat t.d.s
Calcimate 500mg t.d.s
One alpha ,25 ug OD
Ceftriaxone 2gm /24h
Metronidazole 500mg /8h
Miconaze oral gel /6h (Antifungal )
Neubilizer / 6h